RADIATION RESEARCH 189, 541–547 (2018)

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Ó2018 by Radiation Research Society.
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DOI: 10.1667/RR14952.1

Estimates of Environmental Exposure to Radiofrequency Electromagnetic

Fields and Risk of Lymphoma Subtypes
G. Satta,a,1 N. Mascia,a T. Serra,a A. Salis,c L. Saba,d S. Sanna,b M. G. Zucca,b E. Angelucci,e A. Gabbas,a
F. Culurgioni,e P. Pili,e E. Mura,e M. Cappai,d M. G. Ennasb and P. Coccoa
a
Departments of Medical Sciences and Public Health and b Biomedical Sciences, University of Cagliari, Cagliari, Italy; c EPICOOP, Cagliari, Italy;
d
Regional Agency for Environmental Protection of Sardinia (ARPAS), Cagliari, Italy; and e A. Businco Oncology Hospital, Cagliari, Italy

less, our results do not support the hypothesis of a link

Satta, G., Mascia, N., Serra, T., Salis, A., Saba, L., Sanna, S.,
Zucca, M. G., Angelucci, E., Gabbas, A., Culurgioni, F., Pili,
P., Mura, E., Cappai, M, Ennas, M. G. and Cocco, P. Estimates
of Environmental Exposure to Radiofrequency Electromag-
netic Fields and Risk of Lymphoma Subtypes. Radiat. Res.
189, 541–547 (2018).
We investigated the association between environmental
exposure to radiofrequency electromagnetic fields (RF-EMF)
and risk of lymphoma subtypes in a case-control study
comprised of 322 patients and 444 individuals serving as
controls in Sardinia, Italy in 1998–2004. Questionnaire
information included the self-reported distance of the three
longest held residential addresses from fixed radio-television
transmitters and mobile phone base stations. We georefer-
enced the residential addresses of all study subjects and
obtained the spatial coordinates of mobile phone base
stations. For each address within a 500-meter radius from a
mobile phone base station, we estimated the RF-EMF
intensity using predictions from spatial models, and we
performed RF-EMF measurements at the door in the subset
of the longest held addresses within a 250-meter radius. We
calculated risk of lymphoma and its major subtypes
associated with the RF-EMF exposure metrics with uncon-
ditional logistic regression, adjusting by age, gender and
years of education. In the analysis of self-reported data, risk
associated with residence in proximity (within 50 meters) to
fixed radio-television transmitters was likewise elevated for
lymphoma overall [odds ratio ¼ 2.7, 95% confidence interval
¼ 1.5–4.6], and for the major lymphoma subtypes. With
reference to mobile phone base stations, we did not observe
an association with either the self-reported, or the geocoded
distance from mobile phone base stations. RF-EMF mea-
surements did not vary by case-control status. By comparing
the self-reports to the geocoded data, we discovered that the
cases tended to underestimate the distance from mobile
phone base stations differentially from the controls (P ¼
0.073). The interpretation of our findings is compromised by
the limited study size, particularly in the analysis of the
individual lymphoma subtypes, and the unavailability of the
spatial coordinates of radio-television transmitters. Nonethe-
1 Address for correspondence: University of Cagliari, Department
of Medical Sciences and Public Health, Asse Didattico E, ss 554 km
4,500, Monserrato, Cagliari 09042 Italy; email: gianninasatta@
tiscali.it.
541
between environmental exposure to RF-EMF from mobile
phone base stations and risk of lymphoma subtypes. Ó 2018 by
Radiation Research Society
INTRODUCTION
In 2013, the International Agency for Research on Cancer
classified exposure to radiofrequency electromagnetic fields
(RF-EMF) as a possible human carcinogen, based on the
increased risk of cerebral glioma and acoustic neurinoma
reported in several epidemiological studies (1). There were
also suggestions of a possible increase in risk of leukemia
and lymphoma, but limitations in the exposure assessment
made the interpretation difficult, and possible confounding
could not be ruled out (1). After it was reported in 1997 that
lymphoma incidence was increased in mice chronically
exposed to RF-EMF generated by mobile phones (2),
several subsequent animal studies were conducted, which
did not confirm the initial report (3). In an AKR/J mouse
lymphoma model, exposure to UMTS- and GSM-modulat-
ed radiofrequency radiation did result in an increased
incidence, or severity of disease, or a shortened survival
time (4). A recent draft report of the U.S. National
Toxicology Program (NTP) indicated some evidence of
carcinogenicity of GSM-modulated and CDMA-modulated
cell phone RFR at 900 MHz in male, but not female,
Hsd:Sprague Dawleyt SD rats based on the incidences of
malignant schwannoma in the heart, and equivocal evidence
in male B6C3F1/N mice (5, 6). Female B6C3F1 mice
exposed to GSM-modulated cell phone RFR at 1,900 MHz
showed equivocal evidence of an increase in the incidence
of malignant lymphoma (6). A study on cultured Jurkat T
lymphocytes exposed at 1,763 MHz for 24 h (SAR ¼10 W/
kg) did not show significant changes in cell numbers, cell
cycle distributions or levels of DNA damage. On the other
hand, several gene polymorphisms were detected more
frequently in association with RF-EMF exposure, including
mutations in the CXCR3 (chemokine (CXC motif) receptor
542 SATTA ET AL.
3) and IL1R2 (interleukin 1 receptor, type II) genes, whose
function appeared inhibited. However, these changes were
not apparently related to cell proliferation or DNA damage
(7). The above-mentioned NTP draft report also indicated
that evidence of DNA damage was found in the
hippocampus of male rats exposed to CDMA modulation,
and equivocal evidence of such damage in frontal lobe cells.
Responses in the blood leukocytes were likewise equivocal.
No unequivocal evidence of DNA damage was reported in
female rats (5).
An Australian case-control study of non-Hodgkin lym-
phoma (NHL) showed a nonsignificantly elevated risk
associated with occupational exposure to radiofrequency
assessed by applying a job-exposure matrix to the work
history of study subjects (8). A U.S. National Cancer
Institute questionnaire-based case-control study did not
reveal an association with NHL risk among regular users of
cellular phones, nor was there a relationship with frequency
of use (9). In this study, a nonsignificant increase in NHL
risk was observed among men, but not women, associated
with weekly minutes of use, use of a cellular phone for eight
or more years, cumulative exposure and year of first use.
When considering specific lymphoma subtypes, no evi-
dence of an association was detected with risk of diffuse
large B-cell lymphoma (DLBCL) or follicular lymphoma
(9). Post hoc detection of clusters of different types of
tumors, including lymphoma, breast cancer, testicular
cancer, ocular melanoma and nasopharyngeal cancer, was
reported in Israeli radar technicians aged 20–37 years, with
a power density from RF/MW up to 100 mW/cm2 (10). In
two published studies, an elevated risk of NHL was
reported, however, in one of these, only deaths among
Polish radar operators were retrieved and a formal mortality
follow-up was not performed (11); the interpretation of the
results of the second study was limited by several
methodological issues (12). In two other large cohort
published studies, an association with NHL risk was not
observed (13, 14). Concluding their review of the literature
on lymphohemopoietic malignancies, the Working Group
of the IARC Monograph N. 102 stated that the overall
evidence was insufficient for the association of mobile
phone use with either leukemia or lymphoma.
To further explore the role of environmental exposure to
RF-EMF in the etiology of lymphoma subtypes, we used
data from a population-based case-control study conducted
in the Italian region of Sardinia.
METHODS
Study Design and Participants
In 1998–2004, we conducted a population-based case-control study
on the etiology of lymphoma in Sardinia, Italy, as part of the European
multicenter study EPILYMPH. In 1998–2004, 451 incident cases with
a first diagnosis of lymphoma, including all B-cell and T-cell subtypes
and Hodgkin lymphoma, aged 25–74 years, were identified in two
participating hospitals, the A. Businco Oncology Hospital in Cagliari,
and the S. Francesco Hospital in Nuoro, which are referral centers for
diagnosis and treatment of hematological malignancies in the region.
Contact of all lymphoma patients was attempted subsequent to
remission. We excluded 64 cases in which the patients were deceased,
5 patients who were too sick to participate, 26 patients who could not
be located after hospital discharge and 34 who refused participation.
The remaining 322 patients (90.4% of the remaining 356 eligible
cases) participated in our study. We classified lymphoma subtypes
according to the 2001 WHO classification of lymphoma (15). Overall,
the study population comprised 187 B-cell lymphoma cases (including
58 cases of diffuse large B-cell lymphoma, 62 cases of chronic
lymphocytic leukemia (CLL), 24 cases of follicular lymphoma, 24
cases of multiple myeloma and 19 cases of other, less represented B-
cell lymphoma subtypes), 12 T-cell lymphoma cases, 30 Hodgkin
lymphoma cases and 93 cases of not otherwise specified NHL. For the
latter cases, only the diagnosis from the clinical records, and a first
pathology report about the morphological features, but not immuno-
histochemistry, was available, because of dropout from the diagnostic
workup. We included these cases in the analysis of all lymphoma
subtypes combined. A total of 832 eligible controls were randomly
selected from population registries in the same study area, frequency
matched to the cases by gender, local health unit of residence, and
five-year age groups. We excluded 17 deceased individuals, 8 who
were too sick to participate and 62 who were located at the available
address, as well as 299 who refused to participate. Information on the
residential history was not available for two subjects. Therefore, 444
subjects (59.6% of the eligible contacts) remained available as controls
in our study. Controls who refused participation were more frequently
male (58.8% vs.55.9%) and on average older than the participants
(59.0 vs. 56.7 years). No further information was available to assess
representativeness of participants with respect to the randomly
selected population sample.
All participants signed an informed consent form before interview
and blood withdrawal. Trained interviewers conducted in person
interviews with all cases and controls, using a standardized
questionnaire, including sociodemographic data, lifestyle habits, and
health and occupational history. As a special feature of the local study,
a detailed residential history was also available for all the cases and
controls, including the perceived distance from fixed radio-television
transmitters and mobile phone base stations for the three most
prolonged residential addresses, as well as information on several
indicators of vehicular traffic in their proximity.
Environmental Exposure Assessment
We used WinEDTt and ArcGIS 10.1t for desktop to calculate the
spatial coordinates of the three longest held residential addresses of the
participating cases and controls. With the support of the Regional
Agency for Environmental Protection (ARPAS), we identified the
spatial coordinates of mobile phone base stations, located within 500
meters of the residences of the participants. No spatial coordinates
were available for the location of radio-television transmitters. We
also performed RF-EMF measurements at the door of the longest
residential addresses available for the subset of study subjects residing
within 250 meters of the closest radio-television transmitter or mobile
phone base station, using a Microrade broadband detector, Model
Probe 01E. We considered only radio-television transmitters and
mobile phone base stations installed before the onset of the study.
Estimates of environmental exposure to RF-EMF were fourfold.
The first of these was the self-reported perceived distance from fixed
radio-television transmitters and mobile phone base stations, as
mentioned by all cases and controls in the questionnaire, for the three
most prolonged residential addresses at any time of their life. We
categorized the distance in a proximity score as .100 meters (1),
between 50–100 meters (2), and ,50 meters (3); a proximity score of
0 was set for those not reporting proximity to a radio-television
transmitter or a mobile phone base station. For each residential address
we also calculated a cumulative proximity score over the three longest
held residential addresses of study subjects as follows: 1. We
 RADIOFREQUENCY AND LYMPHOMA
multiplied the proximity score by the duration of residence; 2) We
summed up such scores in each study participant; and 3. We
categorized the individual scores with a value .0 in two categories,
below and above the median. The second estimate of RF-EMF
exposure was the exact linear distance as from the spatial coordinates
of the mobile phone radio bases provided by ARPAS. We categorized
the shortest distance from a RF-EMF source over the residential
history (301–500 meters, 201–300 meters, 101–200 meters, 100
meters, with reference to .500 meters); we also calculated the
cumulative proximity score described above and categorized it as
below and above the median. Since results with the cumulative
proximity score did not vary with respect to shortest distance from the
source, we present the results here by categories of shortest distance
from a RF-EMF source. The third estimate was based on ARPAS
spatial models regularly used to estimate the RF-EMF field around
mobile phone base stations. And the fourth estimates were the
measurements of the RF-EMF we performed at the door of a subset of
the longest held residential addresses, which were within a 250-meter
radius of the nearest mobile phone base station.
Semiquantitative indicators of vehicular traffic (low, medium, high,
as perceived by the study subjects), were elicited through the
interview, including presence of a traffic light, frequency of traffic
jams, passage of public transport lines and/or trucks, and presence of a
garage and/or a gas station, within 100 meters from the residential
address. Such indicators were combined into a vehicular traffic score,
which was subsequently categorized into quartiles. In this study, the
vehicular traffic score was used as a covariate to adjust the risk
estimates.
Statistical Methods
We investigated the association between exposure to RF-EMF
emitted by radio-television transmitters and mobile phone base
stations and the odds of occurrence of all lymphomas combined, B-
cell lymphoma, and its most prevalent subtypes: DLBCL and CLL.
We did not investigate other lymphoma subtypes due to their lower
prevalence, and the unstable risk estimates resulting from the small
number of cases. The odds ratio and its 95% confidence interval
associated with the increasing categories of RF-EMF exposure metrics
were calculated using unconditional logistic regression, adjusting for
age, gender, years of education (categorized as 8 years, 9–13 years,
14 years), level of education and quartiles of vehicular traffic in
proximity to the residential addresses of study subjects. Including
local health unit of residence as a covariate did not substantially
change the results. The test for trend was calculated using Wald
statistics.
RESULTS
The distribution of selected characteristics among the
cases and controls is shown in Table 1. The average age of
the cases was 56.7 years (ds 13.39), and that of the controls
was 55.6 years (ds 13.89). The male/female ratio among the
cases was 1.40:1, as expected from the existing knowledge.
Education level and vehicular traffic in proximity to the
residential addresses did not differ between cases and
controls.
The OR of lymphoma (all subtypes combined) and its
major subtypes associated with nearest residence to radio-
television transmitter and a mobile phone base station,
based on the self-reported questionnaire information, is
shown in Table 2. The OR of lymphoma (all subtypes
combined) was elevated for having ever been a resident
within 50 meters of a fixed radio-television transmitter (OR
543
¼ 2.7, 95% CI ¼ 1.5–4.6). The OR was also elevated when
the analysis was limited to B-cell lymphoma (OR ¼ 2.4,
95% CI ¼ 1.3–4.6), and the risk increase likewise applied to
the DLBCL and the CLL subtypes. With reference to
mobile phone base stations, we observed a nonsignificant
excess risk of DLBCL (OR ¼ 2.5, 95% CI ¼ 0.7–8.3), based
on four cases, but not for CLL, B-cell lymphomas or all
lymphomas combined. Results were similar when using the
cumulative score of proximity as the exposure indicator
(data not shown in the Tables).
We did not find an association when distance from mobile
phone base stations was based on the geocoded data, or
when applying the RF-EMF estimates based on the spatial
model provided by ARPAS to the residential addresses
within 500 meters from the nearest mobile phone base
station (Table 3). Since the number of cases and controls
actually residing within 50 meters of the nearest mobile
phone base station was too small, we combined them with
those residing at a distance of 51–100 meters.
By comparing the reported distance to the geocoded data,
we observed that the cases tended to overestimate the
proximity to mobile phone base stations differentially with
respect to the controls; in fact, only one out of 21 cases
compared to 7 out of 30 controls who reported a residence
within 100 meters of a mobile phone base station correctly
estimated their proximity (P ¼ 0.073). Underestimates of the
self-reported proximity to mobile phone base stations also
occurred, but these were similar among the cases and the
controls (P ¼ 0.883) (Table 4).
In a subset of 36 subjects, 18 cases and 18 controls,
whose residence was the longest held address in their
residential history and located within 250 meters of the
nearest active mobile phone radio base, we measured the
electromagnetic field in the radiofrequency range at the door
of their home/apartment. Such measurements were much
lower than those predicted by the models, were not
correlated to the estimates (r ¼ 0.148, P ¼ 0.389), and did
not show a correlation with the geocoded distance from the
mobile phone base stations. The frequency distribution of
such measurements is shown in Fig. 1 by case-control
status. The highest value was a 0.73 V/m, corresponding to
1.31 mW/m2, quite lower than the 6 V/m current Italian
activity level for residential exposures (16), and the 5 V/m
reference level proposed in 2010 by the International
Commission of Non Ionizing Radiation Protection (IC-
NIRP) (17). In interpreting Fig. 1, it is important to note that
the range of the highest exposure category is much wider
than the other categories, and therefore its higher prevalence
is a graphical artefact, since the frequency distribution
approaches progressively diminishing prevalence values as
the intensity increases.
DISCUSSION AND CONCLUSIONS
Our results show an association of risk of B-cell
lymphoma with self-reported residence in proximity to
544 SATTA ET AL.

TABLE 1 proximity. We could not retrieve spatial coordinates for the

Selected Characteristics of Cases and Controls radio-television transmitters. Therefore, whether differential
Cases Controls overestimate of the self-reported residential proximity to
Total 322 (100%) 444 (100%) radio-television transmitters would explain its association
Male 188 (58.0%) 250 (56.3%) with risk of lymphoma subtypes is a matter of speculation.
Females 134 (42.0%) 194 (43.7%) However, it is important that future studies explore whether
Age differential overestimate of self-reported residential prox-
25–30 17 (5.3%) 14 (3.2%)
31–40 35 (10.9%) 47 (10.6%) imity to RF-EMF sources occurs, to interpret the currently
41–50 44 (13.7%) 62 (14.0%) equivocal evidence linking RF-EMF exposure to cancer
51–60 77 (23.9%) 120 (27.0%) risk. Our results were adjusted for intensity of vehicular
61–70 94 (29.2%) 124 (27.9%) traffic in proximity of the three longest held residences of
71–74 55 (17.1%) 77 (17.3%) study subjects and education, but we could not consider
Education
Up to middle school 186 (57.8%) 282 (63.5%) other possible confounders. On the other hand, the
High school 91 (28.3%) 119 (26.8%) definition of lymphomas covers a heterogeneous array of
Higher education 27 (8.4%) 36 (8.1%) etiologically different pathological entities (18); finding a
Not available 18 (5.6%) 7 (1.6%) consistent excess risk across different diseases in relation-
Vehicular traffic ship to the same self-reported risk factor, i.e., residential
None 73 (22.7%) 103 (23.2%)
Scarce 101 (31.4%) 140 (31.5%) proximity to radio-television transmitters, might be sugges-
Medium 94 (29.2%) 127 (28.6%) tive of information bias.
High 54 (16.8%) 74 (16.7%) We had to limit the reconstruction of environmental
exposure to the three longest held addresses; if relevant
exposure would have resulted from the missing part of the
radio-television transmitters, likewise for the two most
residential history, we would not have detected it, which
represented lymphoma subtypes, namely DLBCL and CLL.
might have biased our findings. We also performed
Self-reported proximity to mobile phone-base stations was
measurements at the door of the longest held addresses of
not associated with risk of lymphoma overall and B-cell
a subset of our study subjects who were within 250 meters
lymphoma, and the increase observed for DLBCL cases was of the nearest mobile phone base station, however, we are
not significant. No association whatsoever was observed unable to determine whether current spot measurements also
when the distance between the residence and the mobile reflect past conditions. Because of the subjective nature of
phone radio base was calculated based on geocoded spatial the self-reported information, which might be subject to
coordinates, nor when we used the RF-EMF intensity bias, and the difficulty in reconstructing lifetime exposure to
estimated from models used by the local Agency for RF-EMF with objective measurements, all the metrics we
Environmental Protection. The frequency distribution of used in this study were poor predictors of exposure, which
RF-EMF measurements at the door of a subset of our study would further limit the interpretation of our findings.
population showed that such measurements did not differ by Prospective follow-up studies would better test the
case-control status. We also observed a tendency to hypothesis.
differentially overestimate the self-reported residence in A further limitation in interpreting our findings is related
proximity to mobile phone base stations by case-control to the small study size, particularly in the analysis of the
status, with cases more frequently overestimating their individual lymphoma subtypes. Therefore, the fact that we

TABLE 2
Lymphoma Risk and the Major Subtypes Associated with Cumulative RF-EMF Exposure from Radio-Television
Transmitters and Mobile Phone Base Stations, Based on Questionnaire Information
Nearest residence to radio-television transmitters and mobile phone base-stations
.100 meters 51–100 meters ,50 meters
Disease outcome Cases/control ORa Cases/control ORa 95% CI Cases/control ORa 95% CI
Radio-television transmitters
All lymphomas 275/412 1.0 8/9 1.1 0.4–2.9 39/23 2.7 1.5–4.6
B-cell lymphoma 158/412 1.0 8/9 2.3 0.8–6.1 21/23 2.4 1.3–4.6
Diffuse large B-cell lymphoma 49/412 1.0 3/9 2.0 0.5–8.0 6/23 2.4 0.9–6.3
Chronic lymphocytic leukemia 54/412 1.0 2/9 2.3 0.4–11.4 6/23 2.1 0.8–5.5
Mobile phone base stations
All lymphomas 301/414 1.0 10/19 0.7 0.3–1.5 11/11 1.2 0.5–2.9
B-cell lymphoma 176/414 1.0 4/19 0.5 0.2–1.4 7/11 1.5 0.6–4.0
Diffuse large B-cell lymphoma 53/414 1.0 1/18 0.4 0.05– 2.9 4/11 2.5 0.7–8.3
Chronic lymphocytic leukemia 59/414 1.0 2/19 0.7 0.2–3.2 1/11 0.8 0.1–6.4
a
Odds ratios (OR) are adjusted for age, gender, level of education and traffic intensity.
 RADIOFREQUENCY AND LYMPHOMA 545

TABLE 3
Lymphoma Risk and the Major Subtypes Related to Geocoded Distance from Mobile Phone Base Stations and to the
Estimated RF-EMF at the Residential Addresses
Distance to the nearest mobile phone base stations
501 meters 301–500 meters 201–300 meters 101–200 meters 100 meters
Cases/ Cases/ Cases/ Cases/ Cases/
Disease outcome control ORa control ORa 95%CI control ORa 95%CI control ORa 95%CI control ORa 95%CI
All lymphomas 183/222 1.0 55/94 0.7 0.5–1.1 35/54 0.8 0.5–1.2 37/51 0.9 0.5–1.4 12/23 0.6 0.3–1.3
B-cell lymphoma 105/222 1.0 31/94 0.7 0.4–1.1 18/54 0.7 0.4–1.3 21/51 0.9 0.5–1.5 12/23 1.1 0.5–2.4
Diffuse large B-cell lymphoma 35/222 1.0 9/94 0.7 0.3–1.5 5/54 0.6 0.2–1.6 5/51 0.6 0.2–1.8 4/23 1.0 0.3–3.2
Chronic lymphocytic leukemia 38/222 1.0 10/94 0.5 0.3–1.1 5/54 0.5 0.2–1.4 8/51 0.8 0.3–1.9 1/23 0.2 0.03–1.9
Radiofrequency field estimates
Referenceb 0.01–1.23 V/m 1.24–1.50 V/m 1.51–1.7401 V/m .1.7401 V/m
Cases/ Cases/ Cases/ Cases/ Cases/
control ORa control ORa 95%CI control ORa 95%CI control ORa 95%CI control ORa 95%CI
All lymphomasc 265/366 1.0 12/22 0.7 0.4–1.5 11/21 0.7 0.3–1.5 13/19 1.0 0.5–2.1 15/16 1.2 0.6–2.6
B-cell lymphoma 154/366 1.0 8/22 0.8 0.4–2.0 7/21 0.9 0.4–2.1 9/19 1.1 0.5–2.7 9/16 1.4 0.6–3.4
Diffuse large B-cell lymphoma 47/366 1.0 2/22 0.8 0.2–3.8 1/21 0.5 0.1–3.7 6/19 2.8 1.0–8.2 2/16 0.9 0.2–4.4
Chronic lymphocytic leukemia 53/366 1.0 5/22 1.5 0.5–4.4 0/10 - - 2/19 0.6 0.1–3.1 2/16 0.9 0.2–4.6
a
Odds ratios (OR) are adjusted for age, gender, level of education and intensity of traffic.
b
The unexposed reference included subjects residing at a distance ,500 meters from the nearest radio-television transmitter or mobile phone
base station and those residing within 500 meters, but for whom the estimated RF-EMF was null.
c
The estimated RF-EMF was unavailable for six cases.

were unable to detect an association is not sufficient to
conclusively exclude that such association does actually
exist. Still, with due consideration to all the above
limitations, the observed differential overestimate of the
residential proximity among cancer cases with respect to
controls is worth exploring as a possible explanation of the
contrasting findings across RF-EMF studies.
The carcinogenic effects of RF-EMF exposure have
been the subject of numerous studies, but the variable
sources of exposure and exposure metrics used in such
studies have generated controversial findings (19, 20), and
the hypothesis that environmental exposure poses a health
hazard has often been based on surrogates characterized
by a high level of inaccuracy (21). The few epidemiolog-
ical studies linking environmental RF-EMF exposures to
risk of lymphoma have been conducted in occupational
settings, among mobile phone users and radar operators
(8–14); the overall results have not provided convincing
evidence of an association. However, most of the public
concern has been associated with sources of environmen-
tal exposure. In 2001, an apparent cluster of childhood
leukemia (8 cases) was observed among the population
living within a 6-km radius of a major Vatican radio
station nearby Rome in Italy (22). Risk tended to increase
with proximity to this source of RF-EMF emission, but
the results were difficult to interpret due to the small
number of cases, as well as possible selection and
reporting bias. A post hoc analysis of a cluster of different
types of cancer after the installation of a nearby mobile
phone base station, as claimed by the resident population
of a street in West Midlands, UK, confirmed a 27% excess
of all cancers during 2000–2003, but no significant
increase in disease occurrence at any specific cancer site,
while cancer incidence was below expectation levels

TABLE 4
Self-Reported Compared to Measured Distance between the Residential Address and the Closest Mobile Phone Base
Stationa
Self-reported Distance calculated using geocoded satellite data
distance No. 50 meters 51–100 meters 101–300 meters 301–500 meters 501 meters
50 meters 22 1 5 7 1 8
Cases 11 1 (9.1%) 0 5 (45.5%) 1 (9.1%) 4 (36.4%)
Controls 11 0 5 (45.5%) 2 (18.2%) 0 4 (36.4%)
51–100 meters 29 0 2 14 3 10
Cases 10 0 0 4 (40%) 1 (10%) 5 (50%)
Controls 19 0 2 (6.9%) 10 (52.6%) 2 (10.5%) 5 (26.3%)
 101 meters 709 6 22 155 145 381
Cases 295 3 (1.0%) 9 (3.1%) 62 (21.0%) 53 (18.0%) 168 (56.9%)
Controls 414 3 (0.7%) 13 (3.1%) 93 (22.5%) 92 (22.2%) 213 (51.4%)
a
The spatial coordinates were not available for six cases.
546
FIG. 1. Frequency distribution of the intensity of the electromag-
netic field in the RF range in V/m, measured at the door of the three
longest held addresses in the residential history of a subset of
lymphoma cases and controls, by case-control status.
during the overall observation period (23). Reports of
similar occurrences have been reviewed and issues of
small numbers and reporting bias highlighted (24). While
the extensive review conducted by the Working Group of
the IARC Monograph 102 concluded that ‘‘. . .data from
studies of genes, proteins and changes in cellular
signalling show weak evidence of effects from RF
radiation, but did not provide mechanistic information
relevant to carcinogenesis in humans.’’ (1), a recent
analysis of DNA damage using the Comet Assay among
63 residents within a 300-meter radius of a mobile phone
base station, compared to 28 subjects, whose exposure
was reportedly significantly lower, suggested an increase
among residents near the mobile phone base station, and
daily usage of mobile phones, particularly among females
(25). On the other hand, a published analysis of risk
perception associated with mobile phone base stations and
other sources of electromagnetic fields, performed in
Switzerland, indicated that people who reported living in
proximity to a mobile phone base station did not suffer
from ill health more frequently than people who did not
report a nearby mobile phone base station (26). Also,
frequent users of mobile phones perceived lower risks
than people who used their mobile phones infrequently.
Trust in authorities regulating such matters was positively
associated with perceived benefits and negatively associ-
ated with perceived risk; a correlation analysis suggested
that belief in paranormal phenomena, and belief that most
chemical substances cause cancer, were related to the
perception of harm from RF-EMF and electromagnetic
fields in general (26).
In conclusion, our results do not support the hypothesis of
an association between environmental exposure to RF-EMF
emissions from mobile phone base stations and risk of
developing lymphomas. Further in-depth investigations,
particularly those that objectively reconstruct the lifetime
exposure to environmental sources of RF-EMF, are required
to address concerns about their possible carcinogenic
effects, including risks of specific lymphoma subtypes in
exposed populations.
SATTA ET AL.
ACKNOWLEDGMENTS
This study was supported with funding by the Italian Agency for the
Insurance against Workplace Injuries and Occupational Diseases (INAIL)
(2010 Research Projects on Occupational Diseases and Workplace
Injuries, PI: PC), the Italian Association for Cancer Research (IG grant
no. 11855, PI: PC) and the Italian Ministry of Education, University and
Research (PRIN 2007WEJLZB; PRIN 20092ZELR2; PI: PC). The
funding agencies did not intervene in any phase of data collection and
analysis, interpretation of results or in the writing of this work.
Received: September 28, 2017; accepted: February 12, 2018; published
online: March 16, 2018
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